Client Intake Form-Cleveland Pilates

First Name

Last Name

Email

Phone Number

Birthday

I want to subscribe to the mailing list.

I am...

A New Client (Not Referred)

A Guest of a Current Client (not looking to start on my own yet)

A Referral from a Current Client

Being billed under a Shared Package of a Current Client

For guests, referrals, or shared package members - Type the full name of the Referring Client/ Paying Client below

What is your occupation? What do you typically do daily?(This helps us prepare for occupation related postures/movement needs)

What are your goals? What do you want to benefit most from Pilates?

How did you hear about our studio?

Tell me about your EXPERIENCE with pilates (check all that apply)

No Pilates Experience (mat or reformer)

Mat Pilates experience only

Reformer Pilates experience only

I have done pilates for less than 6 months

I have done pilates for 6 months - 1 year

I have done pilates for over 1 year

I have done pilates for over 3 year

Tell me about your READINESS TO START with pilates (check all that apply)

No contraindication to Exercise and Movement

I have a medical condition, but I've been cleared for Pilates by a health care provider

Tell me about your MEDICAL CONDITIONS (check all that apply)

If you have any concerns about body regions or conditions that you're concerned about list them below (example: hyper-mobility, structural abnormalities, etc)

Are you presently doing other kinds of therapy?

Are you active? If So, what sports/activity/exercise do you do? Frequency/Duration

What is your desired schedule? (check all that apply)

We have shareable packages, meaning you can bring a friend/family member to the studio with you and let them use your credits for their attendance to just join in one time or trial our studio to see if its a good fit before joining on their own.

Every attendee needs to complete a health waiver and intake form prior to coming to class.

Note: This accomodation will often require prior approval as schedule adjustments maybe be needed based on attendees ability and experience to ensure everyone has the optimal experience.

My membership

Is just for me

Will be shared consistently (You and a family member/friend come weekly)

Will be shared periodically with guests

I agree to that the above information is accurate and current

Your Signature

*